A passion for occupational health

In his own words, PRAXES Occupational Health Specialist, Doctor Donald Haigh, recalls how he was first drawn to the occupational health industry. Originally from Halifax, West Riding Yorkshire, England, Haigh moved to Quebec as a child where there was opportunity for his textile worker father in the 1950s. He would go on to study at McGill University and to fall in love with Nova Scotia after working there one summer as a palaeontologist fossil field assistant. In the first of a two part series, he describes how he became a champion of occupational medicine.

Occupational Health and I go back to the 1970s. My background is in mathematics and physics but I went into medicine because of my mother’s encouragement. She was a four foot ten welder and was hell on wheels! She knew that McGill University had a reputable medical school and hounded me for two years until I applied and got in. After my first month, I regretted it because it was dull as dishwater. Conventional and practical medicine didn’t appeal to me so I tried a few different things. Finally, I got a golden opportunity. In Quebec, at that time, the Workers’ Compensation Board put together a program for intervening in high-risk industries and examining the province’s high-risk divisions. They sent teams of doctors, industrial hygienists and occupational health nurses to work with these companies to explore how we could cut down the rates of morbidity connected to work. That was how I first cut my teeth in occupational health.

Next, I went to work at the Department of Community Health and asked them if I would be able to take my time getting my master’s degree in occupational health and they agreed. That was when I discovered that I was really drawn to industrial hygiene (IH) – which is the identification, evaluation and control of health risks in the work place. It’s a form of bio-medical engineering and I like that because it’s pure prevention. You control the agent as opposed to waiting for someone to get sick and trying to fix the situation at that point. I turned my focus to industrial hygiene and continued working for the Quebec government. In 1997, the Workers’ Compensation Board of Nova Scotia, was looking for a specialist in chemical diseases and I landed the job. I worked with them until 2002 and eventually I moved on with a company called Atlantic Offshore Medical Services which was much more specialized in offshore medical problems. In this position, I was doing regulatory exams and mainly offshore work. Next, I worked for Lifemark Health. They did general occupational medicine and rehabilitation for people who had chronic pain. At that time, the Compensation Board had been paying people with chronic pain and they wanted to have less of these cases on their books. They would send these people to a rehabilitation facility for their chronic pain to try and get them back to work. At Lifemark, I worked with people who were expert pain specialists. At this point, Susan Helliwell and John Ross recruited me to come and work for them at PRAXES. We hoped to develop a clinical-based occupational medicine practice, working as an add-on to their on-call EMwerx software system.

Embracing prevention

I’m kind of on the left wing of occupational medicine. I want to prevent injuries and illnesses and there’s not a lot of money to be made in that. You make money in therapeutics. I’m in a trade where money and health are often in direct opposition to one another. When people see me coming they say – “Uh-oh, here comes trouble. He’s going to give us a long list of things to do and find everything we’ve swept under the rug!” About a fifth of our corporate customers recognize the inherent logic in the power and the importance of their labour force. Usually, these are small family businesses or large technical companies who realize the complexity of their industrial process and that they require specialists on every level from the guys in suits to the guys in blue dungarees. They know that these people are a fundamental part of their business and it becomes of interest to protect employees’ health. About a fifth of our customers will hire me to solve safety problems and industrial hygiene contamination problems and put together medical surveillance schemes. The rest of the time I deal with regulatory problems, regulatory examinations with seafarers, divers’ examinations and to make sure workers are healthy enough to do these high-risk, important jobs. Additionally, I offer my expertise to a company on how they should deal with a worker’s illness or injury. I don’t usually work for the employer but rather encourage the employer to work with the Occupational Health and Safety Committee. The Occupational Health Act is there to guide them.

Over the years, I’ve come to learn that work is a village and if someone in your village gets ill, it’s an ecological failure. We have all failed that person. The colleague standing by him at the machine right up to the president at the company, all of us have failed this person and it should not have happened.

Not always a popular profession

There is a phenomena of presentee-ism, which is people working while they are hurt or in pain, and it can aggravate their medical situation even further. Industrial hygiene is prevention and I believe in prevention. Now, prevention is becoming very popular among physicians as well through trying to get people to stop smoking, to manage stress better and to stay at a healthy weight. Those things are important and they are politically very acceptable. Telling a boss that there is too much noise in the air and that’s why he has 15 deafness claims so he should get working on the engineering as well as personal protection and reducing noise levels – that’s very high profile and not always so accepted. It’s not the same as trying to get someone’s cholesterol down. A sawmill owner in Quebec once ran me off his property with a gun. His sawmill was the only industry in town and he didn’t want to hear what I had to say. The next day, I came back with the police and the labour inspector and finally then he decided to do something about his workers’ needs. Occupational health is not always a popular business.

Susan Helliwell and John Ross recognize occupational health as a valuable service. I think they were hoping to get me to cool my jets a little and I did try! One of the key sayings in occupational medicine is: “a worker who isn’t working is ten percent sicker that a worker who is working” and that holds true 30 years out. Ultimately, I am a big champion of occupational health. I may look like Santa Claus but my intervention in many people’s lives is in their working lives. Many workers would opt for something called risk pay and I will not hear of that – I am trying to make jobs safer.

By Dr. Donald Haigh, B.Sc, M.Sc, MDCM, CIME, FCBOM

PRAXES Medical Group opens new clinic in Dartmouth, Nova Scotia

This new clinic is located in the same building as Falck Safety Services, and adjacent to Survival Systems Training. It will now be easier and more convenient to obtain your required medical exams at the same time as your mandatory training courses.

Please note, from November 7 onward, Woodside will be the main PRAXES Clinic location, while our offices will remain in Halifax.

Embracing the offshore life

As an installation nurse, Jonathan Christopher, has the integral role of primary health care provider for an onboard crew working in remote locations offshore. Originally from St. John’s, Newfoundland, Christopher completed a medical assistant course in HMCS Quadra, BC, and became a staff cadet at only 17 years-old teaching First Aid courses in Cornwallis, Nova Scotia. He completed his Paramedic Level I certificate in 1999, Paramedic Level II in 2000 and went on to work on a road ambulance for over four years. In 2008, Christopher completed his nursing degree at Memorial University and began working as an emergency room nurse at St. Clare’s Mercy Hospital. After developing an interest in occupational health and the offshore life, he applied for a position with PRAXES and was hired as an installation nurse in 2015 onboard the Stena IceMAX. Christopher spoke with us about his career path and what it takes to work offshore.

Can you describe what your position entails as an installation nurse?

Onboard the Stena IceMAX, I am the primary health care provider for the crew of the platform in the event of an illness or injury and I maintain all medical emergency equipment onboard including stretchers, First Aid boxes, eye wash stations, AEDS, a register of dangerous drugs and emergency hospitals. I also maintain medical stocks, records and a confidential medical log. Identifying occupational health problems to be referred to the occupational health doctor is also a part of the position and I provide health surveillance of all personnel exposed to hazardous substances during their period of work onboard the offshore installation. Additionally, I conduct training exercises with members of the medical emergency teams.

Another important element is to provide clinical care for personnel and refer cases to company doctors when necessary. I monitor the general health of the crew including respiratory and skin screening that must be reported as an occupational health matter. I will also assist administration in the movement of personnel arriving and departing the installation, assist with helicopter briefings and baggage weights. There are so many exciting elements to my position including promoting general well-being through health promotion activities with provisions of handouts and activities onboard.

What types of medical incidents occur onboard?

Nowadays, there has been a change in the pattern of medical emergencies that occur on offshore installations. In recent years, we have reverted from a pattern of “more injuries than illnesses” to a culture based on increased safety management. As medics working remotely, we must be able to cope with a range of medical emergencies in addition to minor ailments. The majority of injuries that can happen range from minor muscular/ soft tissue injuries sprains/strains and fractures, to severe injuries, falls, and major lacerations and amputations. Gastrointestinal problems, skin issues, respiratory and dental issues make up approximately 65 percent of visits seen in the rig clinic.

Routine or emergency cardiovascular/respiratory cases make up a very little percentage of visits in the offshore industry. Although, these types of medical emergencies are low we must be able to recognize these life threatening presentations immediately, provide prompt treatment based on complaint and undertake specific procedures and administer specific drugs quickly and provide proper care autonomously or under remote supervision.

What characteristics are required to be effective in your job?

I feel that we are often the “front liners” and need to be compassionate and respectful. Honest and straight-forward communication is the best tool to gain respect. It’s also important to diversify and keep abreast of the latest technological advances in both offshore and medical areas. The best advice I can give to anyone looking to pursue this medical field is to be a clear communicator and to listen to the needs of the patient and their concerns. Offshore life is not for everyone but there is no denying that it can be a truly rewarding career.

What do you bring with you for a stretch of time offshore?

Beside my necessities, I bring pictures! My family are my life and I have pictures of them everywhere in my cabin and workspace. My wife, Danielle, made me a picture book that tells the story the story of our milestones together including the birth of our daughter, Ava-Grace, followed by my son, Jon-Thomas. It is my most prized possession and I do not leave for work offshore without it.

Was there a defining moment that inspired you to pursue this career?

My sister really inspired me and helped launch my career path by encouraging me to take my medical assistant course which led me to secure a staff cadet position teaching First Aid when I was only 17 years old. At that time, I had one young student who wasn’t grasping some of the concepts and was in danger of getting sent home. I advised him to come back early from lunch so we could have a teaching session. We did and in the end he successfully completed his course. A year later, a more mature male approached me and let me know that he was the kid I had taken aside. He was so thankful for the life saving skills I had taught him and told me that his uncle had suffered a sudden cardiac arrest several months after summer camp. He performed CPR and was able to keep him alive until the paramedics arrived and revived him. Essentially, he had kept his uncle’s blood circulating and saved his life. To this day, I remember looking at that freckled faced kid and deciding that I knew what I wanted to do with my life – help people.

Three tips for wellness for offshore workers

PRAXES Installation Nurse, Jonathan Christopher, knows first-hand what it’s like to work for long stretches of time away from home and the importance of prioritizing physical and mental health. He gave us three tips for offshore workers striving for wellness in their lives.

Live a life of balance

“Take time to prioritize the things that you enjoy and make time for both work and play. Pick acceptable work hours, prioritize making time to talk to family and friends back home but most importantly – take time for yourself. Make room in your life for hobbies, past-times and interests. The difficulty with working offshore is that these elements are usually absent and maintaining a normal state of mind is critical.” – Jonathan Christopher

Keep active

“Exercise regularly and set clear goals for yourself. This really helps to manage energy levels and release stress. Keeping active helps build stamina and allows you to maximize your health, energy and performance while away in a harsh working environment.” – JC

Maintain a calm perspective

“Offshore plans can change in the blink of an eye and you need to expect the unexpected and be ready, flexible and self-aware. You must be able to react to stressful situations in a calm manner and make quick decisions. Keeping your cool is vital.” – JC

Great Britain crew member, John Charles, reflects on his unforgettable rescue

As one of the greatest challenges on the planet, it is inevitable that the Clipper 2015-16 Round the World Yacht Race crew would pick up injuries during their circumnavigation and the physicians at ClipperTelemed+ and PRAXES were standing by for the duration. One very memorable incident occurred on September 17, 2015, when GREAT Britain round the world crew member, John Charles, was injured during a routine rig climb. With assistance from ClipperTelemed+ (staffed by the physicians at PRAXES), GREAT Britain skipper, Peter Thornton, effectively attended to the injuries Charles had sustained. Thornton reset and splinted Charles’s wrist, inserted stitches to an injury on his upper arm and administered antibiotics and pain killers. As a result, Charles was soon back in stable condition and the team was able to continue racing to Rio. During the Seattle race stopover in April 2016, Charles sat down with us and recalled the events of that memorable day.

You experienced a dramatic incident on the leg to Rio. Can you tell us what happened?

We were sailing from London to Rio and were half way across from the African coast to South America, about a hundred miles above the Equator, and I had to go up the mast to get a halyard back. It had been choppy so we waited for the waves to die down at the end of the day before I went up. Richard Edwards, the cameraman for the race, was with us and he asked me if I would put the Garmin VIRB camera on my head when I went up. Richard wanted me to try to get some footage of the horizon and the boat from the top of the mast, which is about a hundred feet high. I said it was no problem and he was going to film my climb from the bottom and I would film it from the top. As I was getting to the top of the mast, at about 90 feet up, the yacht hit a set of big waves and suddenly I was flying around the top of the mast. I had about ten to fifteen feet of line on me as the boat was rocking from one side to another and I was getting whipped back and forth. I was trying to scrabble on and hold onto anything. I tried to wedge my feet into the mast, which had the main sail up, and my shoes went flying – one went right into the sea and the other landed on deck!

I saw a metal piece of wire that holds the mast up, coming towards me and I put my arms out to try and grab it and it went down my forearm and cut like a cheese grater into my arm. My body kept going and my arm flipped around and I heard my forearm snap and I knew I was in big trouble. This happened in a matter of seconds. Then the boat went – bang, bang, bang – over some waves, and I was flying around again. I didn’t think anything of it at the time but my arm flew back and hit the shroud and I heard it snap. I was actually still filming all of this with the Garmin VIRB and Richard was still filming below. My arm was hanging at a 90 degree angle and I had to grab on with one arm as tightly as I could. Luckily, my right arm is the stronger one and I held on and wrapped my legs around. I was up there for about 46 minutes.

So, what happened next?

Since my arm was broken, it was flapping around and would hit my knee or the shroud and it was so painful, I was nearly fainting. At first, the crew were calling to me from below asking if I could get down but it became clear that there was no way that would happen. They tried to pull me down but because I had knotted myself up behind the main sail and the rigging, it was impossible. They let out the line but I was going nowhere. Finally, my Skipper, Peter, was able to make it up the mast and he had to pull me back up again because I had made knots around myself with the rigging. He took me back up, took me around the sail and through the rigging to untangle me and finally we were able to get back on the deck 46 minutes later and that’s when they started working on me. By this time, ClipperTelemed+ had been informed.

How did Peter work with ClipperTelemed+ once you were on deck?

I remember that I had put on a clean white t-shirt that day and at first I saw a few blood patches but then all of a sudden I had a huge dark patch all over my shoulder. They cut the t-shirt off me and saw that my arm was broken because of the angle it was in and they looked at my underarm where I thought it was only a cut. Peter was told by ClipperTelemed+ that we needed to check this, concentrate on the damage to my upper arm and not to worry about the pain in the lower part of my arm for the moment. Peter had done the training on pigs’ trotters with PRAXES prior to the race so I became his next operation! He put 17 stitches under my arm. At this stage, we were down below in the galley and my arm was giving me more grief than anything but my underarm wasn’t bothering me. It was a numb kind of pain. I was crying out for them to fix the break but the physician at ClipperTelemed+ instructed us to concentrate on stopping the bleeding from above. A crew member was relaying messages from the satellite phone to Peter. He was doing the stitches and getting the messages on what to do and when to do it. After the stitches were done, we addressed the break with adding the support of a metal splint. That was it for ten days until we got to Rio. When I got to the hospital, the doctors there took the splint off and saw that I still had a broken arm but they looked at the stitches and asked where I had them done and if they were done by a professional doctor. They took me to surgery and cut me open to make sure that all the nerves and tendons were still working properly. I had been cut about three to four millimetres away from a main artery and that’s why I was losing so much blood. I have lost a bit of tendon movement and one finger is still a bit numb but that’s it. I am so pleased ClipperTelemed+ was there giving Peter the right information and instructions.

What are your impressions of the service that ClipperTelemed+ provides?

It’s absolutely essential. When something happens in the middle of the ocean it is invaluable to have this type of professional medical advice just a phone call away. All the Skippers and at least one crew member on each team is medically trained by PRAXES before they set off. Some teams will also find they have crew members on board who are professional physicians, but when it comes to remote telemedicine given the stress of the situation, even for them, it is useful to have someone who can tell them what to do and when to do it. If it had been up to me, I was moaning about my forearm and really wanted that to be taken care of first and that would have been a disaster. The physician at ClipperTelemed+ knew exactly what to focus on. In my opinion, that was truly a bad experience made great because all the crew went from novices to people springing into action.

John’s Skipper, Peter Thornton, who treated him on board under the advice of PRAXES, added: “It puts a captain’s mind at rest to know that within minutes of an incident occurring on board that we can speak to a doctor, 24/7, to clarify the treatment and be confident in what needs to be done. Thanks to the training provided by PRAXES in Gosport, and ClipperTelemed+ service on board, I was able to focus on treating John’s injuries, knowing we were doing the right thing. It proved invaluable.”

GREAT Britain round the world crew member, John Charles(photo courtesy of Clipper Round the World Yacht Race)

Doctor Ross hosts Medical Emergencies at Sea

PRAXES and ClipperTelemed+ Medical Director, Doctor John Ross, will be sharing his dynamic telemedicine stories hosting “Medical Emergencies at Sea” on the recently launched and highly anticipated, Boat Radio. Ross will share the fascinating details of far-reaching telemedicine rescues and more with international listeners for this regularly scheduled program launched in July 2016. From impressive resolutions of medical incidents at sea to supporting researchers on expeditions in the world’s most remote locations, Ross has a wide variety of fascinating stories to tell. According to Boat Radio Founder, Mike McDowall, Dr. Ross was the perfect choice to host “Medical Emergencies at Sea.”

“Doctor John Ross has a lifetime of experience dealing with medical emergencies,” says McDowall. “His particular area of expertise – emergencies in remote locations – makes him the ideal person to offer advice to sailors, boat owners and adventurers. Plus, his engaging manner, sharp wit and competence behind the microphone make for a terrific radio program.”

About Doctor John Ross (MD, FRCPC)

Dr. John Ross has been active in the delivery of remote emergency medicine to the marine sector for almost 20 years. He has considerable knowledge of the marine environment, the work pattern of seafarers, and the issues now facing the industry as worker health becomes a business issue. Ross is an emergency physician, a professor of emergency medicine at Dalhousie University (Halifax, Canada) and the Medical Director of both PRAXES Medical Group (Canada) and ClipperTelemed+ (UK). Additionally, he has been a policy consultant to several Canadian and foreign governments.

About Boat Radio

July 1st 2016 was launch day for BOAT RADIO – the first talk station aimed at boat owners, world cruisers, sailing enthusiasts, professional yacht crews and armchair adventurers everywhere. Boat Radio will feature interviews with prominent characters from the world of sailing, exploration and endurance sports. There’ll be compelling tales and inspiring stories often from ordinary people who’ve done extraordinary things and plenty of practical advice and an indelible streak of marine conservation.

Presenters are a mixture of radio professionals, sailing journalists, scientific researchers, ocean ecologists and live-aboard bloggers. Every week there are programs from Florida, Missouri, Washington, The Bahamas, Canada, the Arctic Circle, the United Kingdom, Italy, Croatia, Australia, Mallorca and from boats all over the world’s oceans.

BOAT RADIO’s managing editor is Mike McDowall. Mike has been making radio and television programmes for more than twenty years, working at CNN, APTV, ITN and the BBC. For the past several years, he has produced The World Tonight for Radio 4 in the UK and Business Matters for BBC World Service.
“There are dozens of magazines for boating enthusiasts and a few attempts have been made to develop TV channels aimed at people who mess about in boats,” says McDowall. “What the boating community has never had is a talk radio station. Boat Radio will be slick, professional and a real contender in the world of broadcasting.”

Please visit Boat Radio to learn more
Skype: Boat Radio International
BOAT RADIO can be heard worldwide wherever there’s Wi-Fi or a cellular phone signal

The ClipperTelemed+ partnership is a result of the successful use of PRAXES’ remote medical services for Clipper Race crews during the Clipper 2013 – 14 Round the World Yacht Race. The number of medevacs, in-port hospital visits and insurance claims were dramatically reduced. The results were so strong that Clipper Ventures Plc wanted to provide the service to other mariners.

Clipper Ventures Plc is a highly-respected UK-based company executing a variety of Clipper Events including the illustrious Clipper Round the World Yacht Race – the longest open ocean yacht race in the world.

PRAXES is Canada’s premier supplier of telemedicine for government and industrial clients, providing remote medical support for remote and hostile environments globally including ships, mine sites, oil and gas platforms and prisons. The mission of PRAXES is to improve remote health care while simultaneously reducing cost for clients.

Getting to know PRAXES Account Manager Kaylee Hake

In the spring of 2016, PRAXES Medical Group, welcomed Kaylee Hake to the growing team to take on the exciting position of account manager. Hake grew up in the Annapolis Valley of Nova Scotia and completed her degree in public relations at Mount Saint Vincent University, where she played on the women’s volleyball team. Adventurous in spirit, Hake took a few months off school to work in Sydney, Australia, and eventually returned home to finish her degree. She launched her career working at the advertising agency, Extreme Group, as a busy account manager for multiple clients. After four years, she moved on to the QEII Foundation, where she learned about health care and government relations and met PRAXES Medical Director, Doctor John Ross. Today, Hake brings her diverse work experience to the PRAXES team. She answered a few questions for us on her dynamic new position.

Could you explain what your position as PRAXES Account Manager entails?

I am still new to PRAXES and right now, I am sticking close to Susan Helliwell and the rest of the team to learn about all facets of the business, pitching in where I can, writing a lot, and asking a lot of questions! Eventually I will be working more closely with key clients to ensure our service is meeting their needs – and the doctors as we grow and expand.

In your opinion, what makes PRAXES different than other telemedicine suppliers?

There are many things that make us different. We’ve been delivering telemedicine for 20 years and as a result of this, our doctors are very experienced. We’ve gotten really good at identifying the skills required to be successful and effective at delivering this model of care. Telemedicine is not for everyone. The majority of our doctors are specialized in emergency care and are very comfortable with accessing and delivering care and advice over the phone. They also have a passion for the opportunity telemedicine gives to those who don’t have easy access to traditional care.

What do you think are the most important skills you require for your position?

Like any position, being a good listener is key. What I like about PRAXES is nothing is delivered in box. We are willingly to tailor everything if it means solving a real problem for a client. So, the better I am at listening to the real needs/issues/concerns, the better I will be able to work with the team to develop a good solution. And the other skill is managing expectations – no one likes to over-promise and under-deliver. I am going to work hard to ensure that doesn’t happen.

How do you see the company evolving in the future and in what ways do you hope to contribute?

The next couple of years are going to be really interesting. Health care is tougher than ever and I would love to see telemedicine be a larger part of the solution. There is an opportunity for telemedicine to help alleviate some of the stress on the ‘system’. Just like those in remote areas, there are plenty of people in-land who could use medical advice, support and care at the time when they need it, without having to wait until the traditional system can see them.

When you’re not working, what are some of your favourite pastimes?

Despite my rusty skills, I still play a lot of indoor and beach volleyball, both co-ed and women’s. I love to be outside, moving, running, playing. I love to cook, better known as experimenting. And travel – which is mostly spent trying to find the best place to eat dinner or finding local beach volleyball courts!

PRAXES Account Manager, Kaylee Hake, takes in the view on a trip to Spain

PRAXES supports Return to the Whales Project in remote Patagonia

The largest whale stranding event in recorded history took place in 2015 in the extremely remote region of the Golfo de Penas in Chilean Patagonia. In the unknown fjords surrounding this Gulf, 337 baleen whale carcasses were discovered by a team of scientific divers engaged on benthic marine life studies aboard the sailing vessel “Saoirse”. Later, Keri Pashuk and Greg Landreth, the captains of this vessel, guided another team of skilled scientific researchers to the site in an effort to find the answers to the enigma surrounding the deaths of the whales. PRAXES provides 24-7 medical support for this adventurous team as they explore one of the most isolated regions of the world. Keri and Greg answered a few questions for us regarding their work and why telemedicine is the right choice to support their team.

Can you tell us about your work with the “Return to the Whales” Expedition?

“We just finished up a whale study project here in the Golfo de Penas in Patagonia Chile. In April 2015, we were supporting a team of scientific divers headed by Dr. Vreni Haussermann when we came across 32 whale carcasses on the beaches there. We had to leave the Gulf then, but we felt strongly that more need to be done; we simply couldn’t see 32 dead whales lying there and do nothing about it. We launched a private campaign to seek funding so that we might be able to return with scientists to investigate and in February and May of 2016 we led two study groups coordinated by Dr. Vreni Haussermann and Dr. Carolina Gutstein. They had hired a private plane to fly over the area, discovering a further 200 whale carcasses. After our February trip, the tally went up to to 337 and its now nearly 400. There are many different scientific studies going on during these trips ranging from oceanography to paleontology to red-tide testing. In February, we were even able to conduct three necropsies on the whales and left behind time lapse cameras set up to monitor the areas on a long term basis.” – Keri-Lee Pashuk

In your opinion, why is the support from PRAXES necessary?

“We have been living on the sea for almost 27 years doing many expeditions to places like Antarctica without telemedecine. We never thought about it because it simply didnt exist. Before using PRAXES we had an accident where Greg lost one of his fingers while at sea. It was going to be several days before we could get to land. Though I have advanced wilderness first aid training, I realized that it wasn’t going to be enough and what we really needed was to have an experienced doctor on call. At the time we managed to call a doctor friend of ours who advised me on what to do. Having access to that depth of medical experience takes a lot of the worry out of the expedition. Its pretty lonely out there and its just good to know that there is someone there for us when something serious goes wrong.” – KP

“We’re accustomed to being on our own but in recent years we have been bringing along people who might not be as experienced and, being captains, we are responsible for them. We realized that something serious may eventually go wrong, so the whole idea of having that backup became attractive, then necessary. As time goes on that will become more and more true for all people who work in remote places. We have experienced many extremes in our travels and admittedly we relied a lot on luck in those years but that time has passed. We have had to come to terms with the fact that anything can happen, its a matter of when, not if.” – GL

The “Return to the Whales” Project team leaders, Greg Landreth, and Keri-Lee Pashuk

Have there been many times when your team has had to call PRAXES?

“We did call for a test trial for a minor situation. Our young crew member was having some problems with her fingernails and it was getting worrisome. We got advice on that and it was very helpful. It made her feel much better and we could continue to work for three weeks in an area where the closest doctor was a two day sail away and another six hours by car.” – KP

“It was good to know that the system did work. We know that if little things go wrong, they can quickly multiply, so it was great to test the system and find that it worked very well. There is the real value in that for us – having a standard to measure our own risk assessments and actions against.” – GL

Do you think that telemedicine is an effective medical support system for those working remotely?

“We haven’t had direct experience with a serious emergency when we had to call PRAXES but I think that knowing expert physicians are there for us eases our minds. They are available at any time to advise us on something that we could miss in a moment. Imagine all the possible variables – the boat is moving, there might be a storm and you have to keep the boat going, you can’t stop and you need help.” – KP

“It’s kind of interesting actually. Right now, we are here on our boat next to Puerto Edén, the most remote village in Chile, and there are some medical facilities here but we know that we have access to better medical advice than all the town’s people do.” – GL

What is next for your team?

“The plan is to go back to the Golfo de Penas and continue the whale studies, looking at their behavior with sophisticated tools such as underwater bio-accoustics, filming and documenting the experience as well . Plus, we’d like to set up a semi-permanent base camp with the sailing vessel to study orca attacks on sei whales, something we witnessed on the February trip. We are missing a core part of the project which is the social side. We want to speak with the fishermen, lighthouse keepers and the local people of Puerto Edén and hear their stories about whales and their own interactions with whales. There’s also the whole red-tide thing that’s been menacing the fishery on the entire coast of Chile which may be a factor. We’re still missing a large part of our project, so it’s not over yet.” – KP

“Everyone agrees that there is a strong case for further monitoring in that area. Now, we need to get all interested parties involved including people from the science side, the locals and fishermen and ask what they want us to do. It may be that no-one can ever know exactly why these 400 whales washed ashore but people might not have known about any of it if we hadn’t started this research. We need to build on our presence there. It’s very much worth pursuing and may become a unifying part of the history of the coast. The real value, especially of the last two trips, is that people who would have never known about this are now involved, connected and concerned.” – GL

The “Return to the Whales” team at work
Photos by Keri-Lee Pashuk

Reflections on the first year of business for ClipperTelemed+

The global joint venture between PRAXES and Clipper Ventures, ClipperTelemed+, was ceremoniously launched in April 2015 and has made productive strides in the first year of business. According to ClipperTelemed+ Business Development Manager, Tom Bettle, it’s been an interesting year full of challenges and triumphs. Looking back at the first year of business, Bettle discusses his vision for the future of this dynamic maritime-focused remote medical service.

With over a year of business behind ClipperTelemed+, there have been many positive developments as well as challenges. What is your current focus for the business?

From a personal perspective, I’m even more excited about the business than I was a year ago. We know that the service ClipperTelemed+ provides really works and has amazing consequences for crew. It’s almost so good that the people we’re reaching out to don’t always believe that it’s possible.

You are very interested in further developing the technology component of what ClipperTelemed+ offers. Can you elaborate on this?

To give a very basic description, we currently provide an expert physician to speak with over a satellite phone at any time. It’s a fantastic service and it does amazing things. As technology moves forward and costs of service come down, we are working on options like video, bio-rhythm fit bands and other new developments that we can make work to complement what we already offer.

ClipperTelemed+ has had great results with the Clipper Race and that relationship is very positive and continuing to grow. What are your thoughts on how things have unfolded for this edition of the race?

The race has been an incredible proving ground for what the physicians at PRAXES can do. Initially, when speaking to members of the shipping industry and super yacht owners, it became abundantly clear to me that the cuts, infections, sprains and breaks are incidents that are happening everywhere at sea on ships. The Clipper Race just has a lot more of them. So, the race is a great case study but we need to stop talking about sailors and talk more about seafarers instead.

At this stage, who do you see as the future clientele of ClipperTelemed+?

Anyone who operates in a remote environment where they have limited access to medical care or that medical care is of dubious quality and expensive. We are targeting mariners and focused on the maritime sector first, but really it is a very beneficial service to anyone in a remote setting with limited access to medical care.

ClipperTelemed+ Business Development Manager, Tom Bettle, at the Clipper Race Seattle stopover in April 2016

What are some of your biggest challenges while promoting ClipperTelemed+?

Many vessels have no support at all because they didn’t think they needed it or it was too expensive. We needed to create a service for smaller vessels on a limited budget. It wasn’t complicated – we just took the number of calls we would expect and divided them by the number of crew on that vessel and came up with a customized pricing strategy. We have done that and we’re starting to see value from it. It was a challenge to figure out pricing for all clients. We have a great story to tell and many case studies to back this up. If we can introduce our prospective clients to those who have used and benefited from the ClipperTelemed+ service, this will have a huge impact. Ultimately it will not be the salesman telling the story but the person who has actually used it.

What are the biggest triumphs you’ve had over this past year?

Getting some of the world’s largest superyacht management companies to understand our service and start utilizing it instead of the entrenched competition has been a really positive step. The insurance companies are acknowledging that we’re on to something and listening to us as well now. I’ve also seen for myself how successful the service we provide has been for the Clipper Race and I’m learning how to present that to the rest of the maritime world. These are only stepping stones towards much larger objectives, but we are making great inroads towards them.

What will your strategy be going forward to continue to build the business?

We need to work from both directions. We need to talk to all the individual seafarers, the yachtsmen or the fishermen, who might need the service in small quantities. They will tell their colleagues and friends on the dock but we also need to work from the top downwards by getting maritime organizations to support us. If we can get strong maritime organizations supporting us, we can start encouraging them to provide common sense legislation from the top down so that services like ours become the norm for all seafarers.

Tom Bettle hosts guests aboard the ClipperTelemed+ yacht

7 Seas and 7 Summits adventurer on the benefits of telemedicine

On April 17, 2016, Martin Frey became the first person in the world to climb the Seven Summits and sail the Seven Seas. He began his challenges in the mid 2000s and proceeded to scale the summits one by one. Once the trekking was completed, he turned his attention to the ocean and proceeded to sail halfway around the world with his wife, Kym, and daughter, Lily. In January 2015, Frey joined the EUROPA and Aventura III expeditions to cross the Southern and Arctic Oceans. Next up, he participated in the Clipper 2015 – 2016 Round the World Yacht Race aboard the Visit Seattle yacht to sail across the North Pacific to complete his remarkable achievement of sailing all the Seven Seas. As a vastly experienced mountain trekker and sailor, he firmly believes in the need for telemedicine in remote situations.

Over the course of his 11 year journey, he faced many perils and challenges and realized the immense value of telemedicine especially in remote locations. Frey answered a few questions for us on his recent experience using PRAXES’ service during the Clipper Race and why he thinks it’s a must-have for remote adventurers.

The Clipper Race has been full of dramatic and unpredictable moments. Can you describe what happened when you needed assistance from PRAXES?

We were thousands of miles from land and I started to get red welts and spots all over the back of my hands and we couldn’t figure out why and where they were coming from. Having PRAXES there to call was fabulous. Our skipper, Huw Fernie, was the one to call and I think he was nervous that I was going to have a disease that might take me down. The doctor on the line helped work us through exactly what it was and diagnosed it as trench foot – something that the WWI soldiers had in the trenches in France. We sent a picture through and the fact that she was able to look at it was a big help. We were on the phone for about 30 minutes and she asked subtle questions like – ‘Is it more red around the edges?’. She asked specific questions, things that we wouldn’t have thought to check, and this really made a big difference in finding out what the root cause was. I have sailed through the South Pacific and visited some clinics on tiny islands with very questionable medical practices so knowing that we had a world-class team of physicians to support us through PRAXES was very reassuring.

In your opinion, was PRAXES’ service effective?

Absolutely, I think whenever you have a team race like this or these kinds of situations where you are out in the middle of nowhere, remote medical support is definitely the way to go. I would recommend PRAXES to anyone and I think it was a big help during the race.

What was the outcome of this situation and do you feel it would have been different without PRAXES’ support?

She recommended drying out and staying warm, which we had a good laugh about because those are two things that don’t happen in the Pacific! It’s healed now and I’m doing fine. However, I think we would’ve been quite nervous if it wasn’t properly diagnosed because these red blotches were continuing to spread and it turned out to be because of the wet gloves I was wearing and the conditions we were dealing with.

From your perspective, what are the advantages of having 24 – 7 remote medical support on-call for the duration of the Clipper Race?

Simply having expert advice on-call and to advise on whatever medical situation the crew might be dealing with at any time is a big advantage. Another crew member on our yacht burned herself and we also had more serious incidents to deal with. Just knowing that they were there to support us gave us as race participants a huge sense of confidence going forth on such a dangerous adventure. During my Everest expedition, we had a doctor at base camp on our team and on other expeditions we’ve used a remote medical service and it’s incredibly reassuring. I’m a big believer in it.

Nova Scotia Emergency Management Office (EMO) Emergency Planning Officer, Steve Mills, brings a wide range of knowledge to his current position. Originally from Liverpool, Mills grew up in Bridgewater and went on to have an approximately 31 year career with the RCMP. The now-retired RCMP Staff Sergeant has a consulting and advising role with EMO and also works as a Nova Scotia Ground Search and Rescue Coordinator. Mills has witnessed an evolution within GSAR’s use of technology over recent years. Since 2008, PRAXES has provided Search Management and Record Tracking (SMART) software by Pii Software to GSAR. Mills took time out of his busy schedule to answer a few of our questions on the difference the software makes in search and rescue efforts.

Can you describe what your position with EMO entails and how you work with PRAXES and SMART software?

There are four Emergency Planning Officers in the province and we work with municipalities on their emergency management plans and are involved in emergency management planning on a municipal, provincial and federal level. Additionally, I work as the Ground Search and Rescue Coordinator for Nova Scotia and part of that is working with the SMART Software provided by PRAXES. We started working with this software in approximately 2008 and our role is to help secure financing from National Search and Rescue Secretariat, which is federal funding for the SAR New Initiative Fund. That was the first project and then we went back a couple years later to request further funding to adapt the fund to the Incident Command System, which was recently completed this past July. We help secure funding and I’ve also been on the technical committee since the beginning. We also support our municipalities through helping them with training and any expertise that they require.

Incident Command System is beginning to be used across Canada for Ground Search and Rescue operations and PRAXES is now using ICS forms. Can you tell us about ICS and how this system works?

Incident Command System has been around for some time in the United States and it came to Canada in the early 2000s. Through Parks Canada it has been used for wildfire support and now ICS has been accepted by almost all first-responder agencies across the country. It’s proliferating across Canada and GSAR has been using ICS for many years. When it first emerged, there was a time period of getting it implemented but we’re pretty much there now. ICS creates a uniformed command structure that everyone can use and follow the same terminology wherever you are located. Anyone who’s trained in ICS can go anywhere that it’s used and feel comfortable in their knowledge with the system.

How have the methods of Ground Search and Rescue technology evolved over the years? Are the current methods used efficient?

There’s been a lot of changes in the past ten years including GPS technology, real-time tracking and of course, SMART software. The bottom line goal of all the SAR technology is to assist with finding a lost person in the most efficient way possible. It can take time to get people on-board with new technology however it’s certainly faster to find someone with GPS support as opposed to a compass and map.

How has using SMART Software impacted GSAR’s operations methods?

The goal behind using software is to make a search go faster and more efficiently and ultimately to find the lost person as quickly and safely as possible. What SMART has done, is allowed us to go from a paper-based, clunky, system of tasking people, checking people in and keeping track of volunteers to an electronic system. Now, we can check people in very quickly by use of a scanner. Since their details are already within a program, they pop-up and that information is sent electronically to the search manager and that person knows right away who’s on-site and what skills they have instead of having to ask. There’s a huge time savings there. Being able to task people quickly by simply hitting a button and organizing a structure so that you can create teams and put people together who have complementary skill sets and track the equipment they’re using. It is all-around a huge time saver and in addition to that it creates a permanent record of what happened during the search which we didn’t have in the past.

How does the SMART Software support your work specifically?

Prior to using SMART, we didn’t have this and a lot of information wasn’t documented and was lost. Before 2008/ 2009, it was predominantly a paper-based system. From my perspective, using SMART enables us to tell the ground searcher’s story including how many hours they put in and track their time and that way we can recount their story when seeking funding. We can share details on how much time they’ve put in and what it takes to get teams prepared.

How do do you see GSAR’s use of technology evolving?

Technology continues to make a positive impact. In addition to SMART and Real Time Tracking we also have Project Lifesaver, which is radio transmitter technology that may be used to find people who have Alzheimer’s or Autistic children, for example, who may be prone to wandering. They wear a transmitter and there’s a tracking device that the ground searcher has at their disposal so that they can pick up the signs of that person if they’ve wandered off. Project Lifesaver is making an impact across the world.

SMART works well for us and effectively does what we want it to do. In the future, I think that the software we use will find its way to every GSAR team across the country and the use of drones is also coming into the forefront. Drones work with infra-red and heat seeking technology and they are a very useful tool and I think you will see a lot more drone usage in search efforts in years to come. The last ten years have been full of so many advances in technology and it’s a fast moving, exciting world – so it’s hard for me to predict what will come next. We’re constantly trying to improve on the software and we’ve been heavily involved in always tweaking and continuing to make the system better than ever.

EMO Emergency Planning Officer, Steve Mills

ClipperTelemed+ and PRAXES visit Seattle

In April 2016, ClipperTelemed+ and PRAXES team members gathered in Seattle to show support to the Clipper Race crews after their valiant efforts during the tumultuous Pacific leg. ClipperTelemed+ Business Development Manager, Tom Bettle, PRAXES Dr. John Colebrook, PRAXES Technical Support Specialist, Jeff Scribner, and PRAXES Communications Specialist, Nicole Trask, were there to attend Clipper Race activities, team sailing days and a host of ClipperTelemed+ networking events. It was a valuable opportunity to meet international crew members, colleagues and clients. The team also had the chance to cheer on the yachts as they departed from Bell Marina for their next leg during the beautiful and memorable Parade of Sails.

PRAXES supports Expedition HF27

PRAXES is proud to support a very diverse group of clients. From fishing fleets to round-the-word sailors to expedition groups, our team of expert physicians and dedicated staff have the unique opportunity to support a wide variety of inspiring professionals.

One of the teams PRAXES currently supports is called Expedition HF27. They are investigating the mass whale stranding that occurred in 2015 in the Golfo de Penas, Chile. Last year, there was a stranding of 337 whales in this area and it was the largest mass whale stranding in known history. This area is known for “unruly seas and spontaneous storms.” Expedition HF27 is comprised of a highly skilled team of investigators who are researching why this mass stranding occurred and PRAXES is thrilled to be standing by with remote medical support for any medical incident that arises. To learn more about this truly exciting expedition and find out news on the team’s initial findings, check out their blog here.

Self care is the future of health care

Recently, PRAXES Medical Director, Dr. John Ross, wrote an insightful piece for Doctors Nova Scotia on the role self care plays in long-term health care. As an emergency physician, professor at Dalhousie University and telemedicine provider, he continues to advocate for personal behaviour and public policy change. Please find the full story below.

Self care is the future of health care

Most people, including those of us who are health care providers, think of health care as made up of doctors, nurses, hospitals, CT scans and pills – all the people and things that try to make us well when we get sick. But there is a difference between what we now call health care and what health care could be. Most of us don’t seek out the things and people that try to make us well until after a health problem such as a disease or injury occurs and we want our health back. This is actually “disease care” – reacting to a problem – not health care.

Health care should imply caring for one’s health – staying healthy. After all, repairing broken things rarely results in something as good as the original. Car owners do not wait for the engine to seize up and catch fire to tell them it is time for an oil change – they change the oil proactively based on how far they drive.

So, where does self care fit in?

We believe our public health-care system will be there for us no matter what health difficulties we may face. But here in Nova Scotia, we still find ourselves struggling with getting timely access to primary care providers and we experience long waits for diagnostic imaging, specialists and elective surgery. There are more inconsistencies: we enjoy living in Nova Scotia, yet our province has one of the highest rates of people using anti-anxiety and anti-depressant medications. When Nova Scotians are asked to report on their own health they say it is “good” or “very good,” but general population health studies always report our low ranking in heart, lung and joint diseases.
It seems to me that Nova Scotians have a problem. We seem unaware of the need for self-care.

Let’s look at the data:

The 2013 Canadian Tobacco, Alcohol and Drugs Survey reported:
• 19.4 per cent of Nova Scotians smoke tobacco
• Less than 50 per cent of Nova Scotians get regular physical activity
• 37.5 per cent of people in the province are overweight (compared to 33.6 per cent in Canada) and 25.1 per cent are obese (that is, with a body mass index greater than 29) – almost seven per cent higher than the Canadian population as a whole

We can directly influence all of these behaviours and habits that affect our health. We can prevent, or at least modify, the negative effects. But there are other big society-wide challenges that can interfere with caring for one’s own health, and these challenges cannot be ignored.

The social determinants of health (SDOH) dwarf the too-little-too-late effects of showing up at a hospital when sick. Income and income distribution, education, unemployment and job security, working conditions, early childhood development, food security, housing, social isolation, health services (we spend over 40 per cent of our taxes on health services), aboriginal status, gender, race and disability all influence our personal health outcomes.

For people living in poverty, self-care for a healthy future may be impossible to achieve. For example, for a person who works from 6 a.m. until midnight every day and has to raise a family on a poorly paying job, finding time for self-care is nearly impossible. This is an all too common situation in Nova Scotia.

In the 2015 Report Card on Child and Family Poverty in Nova Scotia, the provincial rate for children living below the poverty line was 22 per cent. The rates increased for Cape Breton: 32 per cent of all children in Cape Breton are living in poverty, with 42.7 per cent of children aged newborn to six years old living below the poverty line. Simply put, one in five children in Nova Scotia and one in three children in Cape Breton lives in poverty.

Children who spend their early years in poverty are at a disadvantage from the start, and their personal health may never recover. Our increasingly expensive “disease-treatment system” is forced to deal with our failure to understand the long term impacts of the SDOH. Nova Scotia could be the first province to redefine ‘health care’ far more broadly than doctors, hospitals, and pills by accepting that a truly healthy, economically-productive population is only possible by directing some health-care dollars to education, housing, affordable good food, employment and other social determinants.

Why not start with dramatically reducing child poverty rates in Nova Scotia and focus on giving all kids a good start in life? This would give them the chance to build healthy habits from an early age. What if more people were encouraged and enabled to be more active – at school, at work, at home? We know that physical activity results in less obesity, lower rates of diabetes, fewer heart and blood vessel diseases, and is also a natural anti-depressant.

What if we redirected more of our tax dollars to programs and services that support communities as a whole? One such program is Nova Scotia’s Community Health Centres, where communities identify their own needs, gather their own resources, work together to practise disease prevention and health care, and innovate locally.
To move our province from “disease care” toward true health-care and self-care, we need to see significant reform. It’s time to make progressive changes to public policy that support individuals in taking responsibility for their own health, encourage us to demand more of each other and demand more of system managers.

Self-care is the future of health care, but it takes more than just going to the gym three times a week and avoiding fast food. Fixing the social determinants of health is complicated, but it can be done. Everyone deserves a fair chance at good health. Everyone deserves a fair opportunity to care for their own health.

PRAXES Technical Support Specialist, Jeff Scribner, recalls his experience working with NSGSAR and describes how their search training events have evolved.

In the summer of 2015, Nova Scotia Ground Search and Rescue led a cutting-edge series of mock rescue training events for Search and Rescue members. A branch of PRAXES Medical Group called Pii Software has been providing project support, training and software for NSGSAR for the past five years. As part of a recent New Initiatives Fund grant, which goes towards development improvements of the software, an exciting series of five training events took place in Debert, Oyster Bay, Whycocomagh Provincial Park in Cape Breton, and other Nova Scotia locations.

Previous NSGSAR training sessions occurred in classroom settings with teams bringing their laptops and being led through software functions. The 2015 round of training took a hands-on approach, putting teams out in the field with mock search events. Essentially, everything was conducted as if it were a real life search event but the “lost person” was actually an object placed in the woods by event organizers. Representatives from Pii Software attended each of the events to observe and support.

As part of the in-depth training event, all teams were expected to complete a series of tasks. Some of these tasks included demonstrating the ability to check all their members in to the software, enter search information, create tasks, dispatch teams in an acceptable time, record communications with the teams in the field, find the “lost person” and generate reports using the software. Only when all tasks had been completed and verified would the teams be finished. An added and welcome incentive for finishing all the tasks – lunch was provided. By this point, the teams had all worked up hearty appetites!

Command base set-ups vary a great deal from team to team, but generally speaking there is at least one designated laptop for the software while another laptop is designated for other programs used (Real Time Tracking and Ozi Explorer mapping). These laptop stations are located in a vehicle that the team uses as a command station. The vehicle also houses a wide array of equipment the team uses including radios, GPS devices, radio repeaters and large detailed maps of the area. According to NSGSAR Technical Committee member and Eastern Shore volunteer Billy Dunn, the program was effective and efficient.

“The software has reduced the number of people needed in the command bus,” said Dunn. “It hasn’t created more bodies in the bus”.

After speaking with members of different GSAR teams, the benefits of using the software became very clear. Before using the software, everything was recorded using paper. A member of the Cheticamp team mentioned that before using the program it would take between two to four hours for the command station to get organized and send the first team out in the woods to search. Now, it rarely takes more than 30 minutes to get the first team in the field.

NSGSAR team members prepared for an event in Whycocomagh Provincial Park, Cape Breton.

Command centre for NSGSAR event in Oyster Pond, NS.

Providing telemedicine to the corrections industry

Telemedicine has been gaining momentum as an efficient and cost effective option for healthcare within a diverse variety of industries including corrections. Given the unique environment of a correctional facility, there is potential for a range of telemedicine applications from consultations to emergency support. PRAXES’ Doctor Donald Fay has been working with Southwest Nova Scotia Correctional Facility in Yarmouth for approximately ten years providing weekly consultations regarding inmates. Fay also operates his own family practice in Halifax and has twenty years of experience working with patients dealing with addictions. With a background as a control systems engineer, he also has a special interest in biomedical engineering and medical records. Dr. Fay answered a few questions for us on the unique nature of his ongoing work in corrections.

Can you describe what your position with PRAXES entails?

PRAXES has a contract with Southwest Nova Scotia Correctional Facility to provide three consultations per week working with a nurse who meets with the inmates in person. Every Monday, Wednesday and Friday, I have a phone consultation with the nurse who will have a list of inmates to discuss who have been in her clinic that day. We go over the different cases in detail and the medications that might be needed.

In your opinion, what are some of your biggest challenges in regards to working remotely?

From my perspective, participating in our phone consultations is like listening to the radio. You have this idea in your mind and a person is being described to you but you’re not actually seeing them. My ears and eyes are the nurse because she does see the inmates and listens to them and has a very good sense of their character. I see through her eyes and she is excellent at seeing what is in front of her. In terms of the medications, there are very strict rules and narcotics are very rarely prescribed. I’m not able to prescribe narcotics to the inmates but I do know how to taper and get people off these drugs.

Can you give us any examples of the types of medical incidents that you treat in corrections?

There are many psychiatric conditions such as depression, anxiety disorders and personality disorders that arise. Often these issues are initially in the background for inmates and then come to the foreground. A broad spectrum of psychiatric and personality presentations are there, along with the manipulations that occur in terms of inmates trying to get certain things. In that department, Debbie, our nurse, is fantastic. She is able to diagnose these situations very quickly and I often formulate the same impression as she describes them on the phone without the advantage of seeing that person. Her descriptions for me are so clear and she very carefully and succinctly describes each situation.

You have a great deal of experience working with patients battling addictions and you also have a background as an electrical engineer. Do these unique skills come into play in your role with PRAXES?

My sub-branch within electrical is as a control systems engineer so I’m interested in systems and how they work. The technology I’m using for Southwest Nova is straight-forward but I’m interested in human communications as well as communications that may be in place to deliver something at the other end. It happens to be humans that we’re working with rather than missiles or space vehicles, and I find that very intriguing.

Over the last twenty years, I have also had quite a bit of experience in treating drug addiction. Many people with drug addictions have had very rough lives and have criminal records. I’ve had a lot of exposure to this population and a high percentage of the inmates at Southwest Nova have similar demeanours, attitudes and approaches to those of my patients with addictions issues. It was about ten years ago when methadone was approved as a treatment component in opiate addiction and previous to that we didn’t really have an effective option. I was one of the few private practitioners to get a methadone license and we were finally able to treat opiate addictions. We couldn’t do that effectively before the introduction of methadone. I think that this experience helps me in regards to my work with PRAXES. I can connect right away with the nurse’s description of her clients at Southwest Nova and the conversations resonate with me.

Do you think that telemedicine is an effective option for healthcare within corrections?

The work I’m doing with the facility in Yarmouth only involves the telephone and a fax machine but if you look at the telemedicine technology that is available and how cost effective it is, we could easily treat many patients through the audio-visual tools that are available. However, I don’t believe in applying technology for the sake of applying technology. Sometimes all you need is the telephone, which is what we’re doing with the corrections facility at this time – and it’s very effective.

One of the advantages to our system is that there’s only been one week in ten years, that I have not participated in our consultations. No matter where I am in the world, through the internet I can connect to my server in my office and have secure access to everything I need. The technology that we’re using really allows me to go anywhere. In terms of telemedicine, that’s an area that’s just going to expand because there’s so much potential there in terms of interactive consultations, distant physical examinations with cost effective electronics, and connectivity with provincial resources. The technology is available today and is at the right price.